Hi, I was wondering how much time do residents typically take to preround and prepare a complete presentation on every general pediatric patient? How about every NICU/PICU patient? I hit an invisible wall when I reach 4 patients (I'm a medical student) and am looking for ways to improve my efficiency when I need to carry eight patients in the beginning of intern year.
(by invisible wall I mean I start to get scared of overlooking stuff so I take half an hour per patient and can't help it for some reason).
thanks for your help!
PreRound at my institution means "time with the resident seeing patients before we round with the attending." Im going to assume you mean "the time from when I get into the hospital to the time we round with the attending." If I'm off on that, this may sound funky.
A normal day goes something like this:
1.
Data Collection. I find a computer and start collecting vitals and labs for every patient I have. This involves starting the progress notes (I hand write the notes) with medications listed on the side, vitals, and lab values. I also copy them into my patient tracker, which for me is a moleskin. Since Im following my own patients, I generally have an idea of what Im looking for (i.e. How did BP do? Hgb drop?), but do copy everythingdown.
2.
Eyes on. Once data collection is complete I go see patients. Here is where I now DO something different from what I tell students to do. On admission, I am thorough, I am complete, my physical is meaningful. On subsequent days its "is the fluid on lungs better or worse" or "is the cellulitis decreased?" So I am focused. Patient gets a little talking to (5 minutes tops) and a touch of an exam (2 minutes if they are lucky). Again, I know what I'm looking for so I go straight to it.
That being said, I generally convince my students to be more thorough. Afterall, it is their opportunity to get some experience to the physical exam. So I would say my students spend about 15 minutes with each patient, rather than my 5.
3.
Notes After data collection and eyes on, I finish up the notes. We are expected (not just encouraged) to have a plan ready for resident rounds. Orders are supposed to be in the chart. If something doesn't need to be done, we'll cancel it. writing the notes probably takes the longest time becuase, as a medicine resident, I have to care about everything, and I rewrite the plan (often without discussion if the discussion has not changed) for every problem every day.
4.
Total Time . Im usually ready to rock in two hours. I've taken on as many as 14 in 3 hrs, but usually have 5 in 2 hours. If there are less patients, more time gets spent with the medical student. Then we Resident Round for an hour. Then Attending rounds for as long as she wants us to be there. "Preparing a presentation" sort of comes naturally. Once the information is in my patient tracker, it just flows. Its more about the paperwork than practicing the presentation. That's what the resident rounds are for; students (or weaker interns) practicing their presentations.
Bottom Line: 30 minutes a patient is solid. Data collection, seeing the patient, presentation ready. If you write a detailed note, maybe even has long as 45 minutes for a student.
Edit: 5 minutes per patient if surgery. Seriously, stay focused.
